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General NPI Number Information
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NPI Number | 1134188105
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Entity Type | Individual
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Provider Name | EDDY TOUSSAINT PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 460 NORTHSIDE CHEROKEE BLVD STE 100
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City | CANTON
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State | GA
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Zip | 30115-8017
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Country | US
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Telephone | 770-292-3490
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Fax | 770-721-5615
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Provider Business Mailing Address
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Address Line | 980 JOHNSON FERRY RD STE 1040
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City | ATLANTA
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State | GA
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Zip | 30342-1626
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Country | US
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Telephone | 770-292-3460
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Fax | 404-300-2317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004561
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License Number State | GA
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